The predictive value of pressure recording analytical method for the duration of mechanical ventilation in children undergoing cardiac surgery with an XGBoost-based machine learning model

Abstract

ObjectiveProlonged mechanical ventilation in children undergoing cardiac surgery is related to the decrease in cardiac output. The pressure recording analytical method (PRAM) is a minimally invasive system for continuous hemodynamic monitoring. To evaluate the postoperative prognosis, our study explored the predictive value of hemodynamic management for the duration of mechanical ventilation (DMV).MethodsThis retrospective study included 60 infants who underwent cardiac surgery. Cardiac index (CI), the maximal slope of systolic upstroke (dp/dtmax), and cardiac cycle efficiency (CCE) derived from PRAM were documented in each patient 0, 4, 8, and 12 h (T0, T1, T2, T3, and T4, respectively) after their admission to the intensive care unit (ICU). A linear mixed model was used to deal with the hemodynamic data. Correlation analysis, receiver operating characteristic (ROC), and a XGBoost machine learning model were used to find the key factors for prediction.ResultsLinear mixed model revealed time and group effect in CI and dp/dtmax. Prolonged DMV also have negative correlations with age, weight, CI at and dp/dtmax at T2. dp/dtmax outweighing CI was the strongest predictor (AUC of ROC: 0.978 vs. 0.811, p < 0.01). The machine learning model suggested that dp/dtmax at T2 ≤ 1.049 or < 1.049 in combination with CI at T0 ≤ 2.0 or >2.0 can predict whether prolonged DMV (AUC of ROC = 0.856).ConclusionCardiac dysfunction is associated with a prolonged DMV with hemodynamic evidence. CI measured by PRAM immediately after ICU admission and dp/dtmax 8h later are two key factors in predicting prolonged DMV.

The Use of Pressure Recording Analytical Method in Patients Undergoing Endovascular Repair for Abdominal Aortic Aneurysm: The Impact on Clinical Decisions for the Appropriate Postoperative Setting and Cost-effective Analysis

“…In other Centers, the PRAM system has been used to monitor patients with septic shock (38), in patients undergoing major abdominal surgery (39) or cardiac surgery (1,40). Moreover, PRAM has been also used in pediatric patients (41)(42)(43), in patients under spinal anesthesia for elective cesarean section (44), and in patients with veno-venous extracorporeal membrane oxygenation therapy (45).…”

MostCare-Based Assessment of Cardiac cycle efficiency in Coronary Artery Disease Patients: High-flow nasal cannula versus standard oxygenation for gastrointestinal endoscopy with sedation. The prospective single-center randomised controlled MEHIS study protocol

“…7 After cardiac surgery, infants entering the ICU, MostCare data can effectively monitor cardiac dysfunction and predict mechanical ventilation duration. 8 In adult patients undergoing off-pump coronary artery bypass surgery and those receiving veno-venous extracorporeal membrane oxygenation therapy, the use of MostCare shows good consistency and trending in detecting cardiac output compared to intermittent pulmonary artery thermodilution 9 and transthoracic echocardiography 10 , respectively. Furthermore, in hemodynamically unstable patients (including those with conditions such as ventricular failure, vasoplegic shock, hypertensive crisis, hypovolemic shock, and aortic valve stenosis), there exists a good correlation between MostCare data and high-fidelity human patient simulators.…”